New onset of insomnia in hospitalized patients in general medical wards: incidence, causes, and resolution rate

Abstract

Background: Insomnia is common in hospitalized patients. However, no study has examined new onset of insomnia in patients without a prior history of insomnia. Objectives: Incidence of new onset of insomnia in inpatients, associated factors and resolution rate after 2 weeks. Method: This is a prospective observational study conducted at a community hospital. We used the Insomnia Severity Index questionnaire to screen for insomnia in all patients located in the general medical floors from day 3 to day 5 of their hospital stay. We excluded patients with a prior insomnia history. Results: Out of the 205 patients who met the inclusion criteria, 75 patients (36%) reported insomnia. Severe insomnia was present in 3% of patients. Difficulty in maintaining sleep is the most common symptom. Frequent staff disruptions due to blood draws and vital signs checks were reported by 68% as the cause of insomnia, followed by illness associated causes (64%) and sleep disruption due to noise and or brightness (23%). Patients with insomnia had more awakenings due to noise, brightness, and staff interruptions than those without insomnia (1.35 times vs. 0.9 times, p = 0.027). Patients with respiratory symptoms, cardiac monitoring, oxygen use, private rooms, and no sedative use did not have a higher insomnia risk. Patients with insomnia had significant lower satisfaction scores than patients without insomnia (4.53 vs. 4.05, p = 0.001) but did not have a different length of stay (6.18 vs. 6.19, p = 0.97). In 31% of patients with insomnia who were able to be contacted two weeks after discharge, 75% of them had insomnia resolution. Conclusion: New onset of insomnia occurred in 36% of hospitalized patients. Most common causes are staff disruption and disease symptoms. It was usually short-term and could decrease patients’ satisfaction score.

Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions

“…Poor sleep is associated with hypertension and other cardiovascular risk factors, poor glycemic control, cognitive decline, and increased vulnerability to mental health problems [6][7][8][9], all of which may be compounded in medically and psychiatrically vulnerable populations. Furthermore, poor, altered, and/or fragmented sleep while hospitalized is linked with greater disability ratings at time of discharge, poorer healthcare satisfaction, greater short-and longterm functional impairments, increased medical complications, and increased mortality rates in a variety of medical and psychiatric patients [10][11][12][13][14][15].…”

<p>Is Agomelatine Associated with Less Sedative-Hypnotic Usage in Patients with Major Depressive Disorder? A Nationwide, Population-Based Study</p>

“…This might support the previous findings that sleep disorders are prevalent in patients with more medical comorbidities 43,44 or even need a higher medical attention. 45,46 In addition, there appeared to be more middle CCI scores as 2, 3, and ≧ 4 in the other antidepressant group. There is no study, as yet, for the agomelatine treatment for depression in people with physical comorbidities.…”

Let Sleeping Patients Lie, avoiding unnecessary overnight vitals monitoring using a clinically based deep-learning model

“…VS assessments are the second most common cause of sleep disruption in the hospitalized patient 16 , and safely reducing these interventions overnight can improve patient sleep quality and quantity while leading to better health outcomes. Multiple studies have measured the quality and quantity of sleep in hospitalized patients around the world, showing significant reductions in sleep quality for patients in North America 1,2,7 , Europe 17 , and Australia 18 , among others. This sleep quality reduction has been linked to a range of adverse health outcomes, including delirium; cardiac and metabolic derangements; cognitive impairment, especially in older adults 4,19 ; development of various pain conditions; elevation of inflammatory markers; a decline in self-reported physical health-status 20 ; weakened immunity; hypertension; elevated stress hormones; and increased mortality 3 .…”